Pulmonary stromal expansion and intra-alveolar coagulation are primary causes of COVID-19 death.
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Szekely L, Bozoky B, Bendek M, Ostad M, Lavignasse P, Haag L, Wu J, Jing X, Gupta S, Saccon E, Sönnerborg A, Cao Y, Björnstedt M, Szakos A
Heliyon 7 (5) e07134 [2021-05-00; online 2021-05-24]
Most COVID-19 victims are old and die from unrelated causes. Here we present twelve complete autopsies, including two rapid autopsies of young patients where the cause of death was COVID-19 ARDS. The main virus induced pathology was in the lung parenchyma and not in the airways. Most coagulation events occurred in the intra-alveolar and not in the intra-vascular space and the few thrombi were mainly composed of aggregated thrombocytes. The dominant inflammatory response was the massive accumulation of CD163 + macrophages and the disappearance of T killer, NK and B-cells. The virus was replicating in the pneumocytes and macrophages but not in bronchial epithelium, endothelium, pericytes or stromal cells. The lung consolidations were produced by a massive regenerative response, stromal and epithelial proliferation and neovascularization. We suggest that thrombocyte aggregation inhibition, angiogenesis inhibition and general proliferation inhibition may have a roll in the treatment of advanced COVID-19 ARDS.
PubMed 34056141
DOI 10.1016/j.heliyon.2021.e07134
Crossref 10.1016/j.heliyon.2021.e07134
pmc: PMC8141733
pii: S2405-8440(21)01237-8